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Doença periodontal, tabaco e parto pré-termo
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O parto pré-termo (PPT) está associado a alta mortalidade e morbilidade perinatal, sendo os custos com os recém-nascidos pré-termo (RNPT) igualmente elevados, quer para as próprias famílias quer para o Sistema Nacional de Saúde. No entanto, tem havido dificuldade na redução da sua incidência, pois são vários os factores implicados. Existe evidência científica que suporta a relação entre a doença periodontal e a ocorrência de parto pré-termo. Parece ser consensual, de igual modo, considerar o tabaco um factor de risco da doença periodontal, embora a sua relação com o PPT ainda não seja clara. Os objectivos deste estudo visaram avaliar e caracterizar o estado periodontal/dentário num grupo de puérperas, avaliar a sua exposição tabágica e relacionar os indicadores periodontais/dentários e a exposição tabágica com a ocorrência de PPT. Realizou-se um estudo, caso-controlo, com 237 puérperas do Internamento do Serviço de Ginecologia e Obstetrícia do Hospital S. João, E.P.E. nas primeiras 48 horas após o parto: 86 de RNPT espontâneo com idade gestacional inferior a 37 semanas de gestação (grupo-caso) e 151 de RNs de termo e peso ao nascimento igual ou superior a 2500g (grupo-controlo). A prevalência de patologia do foro periodontal encontrada na população estudada foi extremamente elevada, nomeadamente a inflamação e recessão gengival, apresentando mais de 30% das puérperas valores de profundidade de sondagem iguais ou superiores a 4mm. Dos indicadores periodontais estudados, apenas a presença de recessão em mais de dois dentes parece aumentar o risco de PPT em cinco vezes. (OR=5,28; IC95%: 1,63-17,04). A associação encontrada entre o valor aumentado de profundidade de sondagem e o consumo tabágico durante a gravidez poderá ser relevante, dado que 20% das puérperas de RNPT fumaram durante a gravidez e a proporção das mulheres que deixaram de fumar neste grupo foi cerca de metade da proporção observada no grupo-controlo. Existe, portanto, a necessidade de englobar a informação relativa a esta temática na educação para a saúde, não só da grávida, mas de toda a população em geral, alertando para os malefícios do tabaco na doença periodontal, na grávida e no recém-nascido. Intervenções para ajudar a grávida a deixar de fumar deverão fazer não só parte da Consulta de Saúde Materna e Obstetrícia mas também da Consulta de Medicina Dentária.
Preterm delivery is associated with high mortality and morbility perinatal, being the costs dispended by the family and the National Health System with preterm newborns extremely high. However, it has been difficult to reduce its incidence due to the various factors involved. There is scientific evidence which support the relationship between pe- riodontal disease and preterm delivery. There is also evidence of tobacco as a risk factor for periodontal disease, even though the relationship with preterm delivery is not yet clear. The aims of our study were to evaluate, in women in a post-partum period, dental and periodontal status as well as the exposure to tobacco and to establish the relationship between these two factors with preterm delivery. We performed a case control study with 237 parturient women from the Department of Obstetrics and Gynecology of Hospital S. João, E.P.E., during the first 48 hours after birth. A total of 86 gave birth at a gestational age under 37 weeks (case group ) and 151 gave birth to term newborns with birthweight equal or superior 2500g (control group). The prevalence of some indicators of periodontal disease in the studied population was extremely high, namely gingival inflammation and gingival recession, and more of 30% had values of probing depth equal or higher than 4 mm significantly. Based on these perio- dontal indicators, only the presence of recession in more than two teeth seems to increase the risk of preterm delivery in fivefold (OR=5,28; IC95%: 1,63-17,04). There is a statistically significant association between probing depth equal or higher than 4mm and smoking during pregnancy. This association might be relevant because 20% of preterm newborns mothers smoked during pregnancy and the proportion that stopped smoking during pregnancy in this group of mothers was almost half of the number of the control group. Therefore it is necessary to embody the information about this thematic in the health edu- cation, not only in pregnant women but in the general population, alerting for the smoking influence in periodontal disease, in pregnant women and in newborns. Interventions to help pregnant women to stop smoking should be included, not only in prenatal care guidelines used in hospitals, but also by dental medicine providers.
Preterm delivery is associated with high mortality and morbility perinatal, being the costs dispended by the family and the National Health System with preterm newborns extremely high. However, it has been difficult to reduce its incidence due to the various factors involved. There is scientific evidence which support the relationship between pe- riodontal disease and preterm delivery. There is also evidence of tobacco as a risk factor for periodontal disease, even though the relationship with preterm delivery is not yet clear. The aims of our study were to evaluate, in women in a post-partum period, dental and periodontal status as well as the exposure to tobacco and to establish the relationship between these two factors with preterm delivery. We performed a case control study with 237 parturient women from the Department of Obstetrics and Gynecology of Hospital S. João, E.P.E., during the first 48 hours after birth. A total of 86 gave birth at a gestational age under 37 weeks (case group ) and 151 gave birth to term newborns with birthweight equal or superior 2500g (control group). The prevalence of some indicators of periodontal disease in the studied population was extremely high, namely gingival inflammation and gingival recession, and more of 30% had values of probing depth equal or higher than 4 mm significantly. Based on these perio- dontal indicators, only the presence of recession in more than two teeth seems to increase the risk of preterm delivery in fivefold (OR=5,28; IC95%: 1,63-17,04). There is a statistically significant association between probing depth equal or higher than 4mm and smoking during pregnancy. This association might be relevant because 20% of preterm newborns mothers smoked during pregnancy and the proportion that stopped smoking during pregnancy in this group of mothers was almost half of the number of the control group. Therefore it is necessary to embody the information about this thematic in the health edu- cation, not only in pregnant women but in the general population, alerting for the smoking influence in periodontal disease, in pregnant women and in newborns. Interventions to help pregnant women to stop smoking should be included, not only in prenatal care guidelines used in hospitals, but also by dental medicine providers.
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CELOM